And are the nurses trained on that point-of-care machine or is the laboratory the only ones that can handle it? Knowing who’ s going to draw specimens, and also who’ s going to perform that testing, knowing if you have open platforms or closed platforms, and that really goes back to that collaboration piece and engaging with your lab leadership. So, identifying those clinical tests that you can do in your facility, whether you’ re a level 4, level 3 or level 2 facility, and then communicating that lab tests that you can do safely with your providers in the emergency department before this instance occurs.”
Prather reiterated that actionable items include incorporating lab collection into your plan; partnering with your lab leaders to determine what testing you can perform at your facility; engaging with your local public health partners to validate communication / coordination processes; and knowing who your public health lab is and if you have an identified courier that can transport suspect.
Cleaning and disinfection is another key weapon against potential HCIDs.
“ First, we need to talk about who’ s performing the cleaning and are they trained on using the proper PPE?” Prather noted.“ If you have that patient identified and in isolation, you’ re not going to want a lot of extra people in that room, so make sure that that nurse or trained observer or whoever’ s in there in that PPE is set up to clean whatever’ s coming your way. You also need to address which Environmental Protection Agency( EPA)-registered disinfectants are listed on List L for Ebola, and List Q for emerging
Click to see the July 2024 issue of Healthcare Hygiene magazine for coverage of APIC’ s 2024 conference
special pathogens. Is the disinfectant you will be using liquid, solid, or vaporized? Do you have protocols for those? You must also ensure that there is proper signage available, to prevent entry into that room, and then have a checklist for caregivers regarding what’ s visibly contaminated versus just high-touch, high-clean surfaces that you’ re going to want to hit in those rooms as they’ re giving care. And then also when that patient is transferred out, is the nurse doing the first round of cleaning and disinfection or is your environmental services team going in after?”
Training and education around HCIDs is the Joint Commission’ s Element 2: The hospital develops and implements education and training and assesses competencies for the staff who will implement protocols for high-consequence infectious diseases or special pathogens.
Prather recommends developing a“ superuser” team with representation from all shifts. Superusers can be charge nurses and other engaged clinicians who receive special training on HCIDs in a train-the-trainer program.“ Some of the approaches that we’ ve taken are tapping into skills fairs with a station for testing PPE donning and doffing and workflow review, as well as on-shift walk-through drills, staff meetings, and implementing a just-in-time( JIT) training plan.”
Arguinchona shared an exercise that a colleague uses, a drive-by tool that is scenario-based and provides a 5-minute JIT education.“ She created a scenario based on an outbreak that might be happening, and she just walked up to clinicians asking them‘ What they would do if I told you that I have a bad headache, a fever and I’ m feeling weak and I just got back from Rwanda. What would you ask me? Where would you document that? What resources are available to you?’ It can be as simple as that and then adjusting education for that caregiver based on the answers they give you. There are also mystery-patient drills that utilize a caregiver acting as a patient, which can be very good ways to instruct about HCIDs.”
High-Priority Pathogens
In the APIC session,“ High-Priority Pathogens: Epidemiology, Potential Spread, and Infection Control Response,” presenters Doe Kley, RN, MPH, T-CHEST, LTC-CIP, CIC, and Mariana Torres Portillo, MD, provided an updated account of current high-priority pathogens with their potential for spread into and within the U. S.
At last year’ s conference, Kley and Torres addressed emerging pathogens that are increasing in frequency and consequences of delayed identification and diagnosis. This year, they provided a deeper dive into the epidemiology and the specific IP & C measures for two high-priority pathogen threats for the U. S. – avian Influenza and measles.
Torres shared with attendees the disease profile and epidemiology for H5N1 avian influenza virus, noting that as an enveloped viral agent, it is susceptible to heat, detergents, and alcohol. It is transmitted animal-to-human and is enzootic in birds while panzootic among many animals. Regarding transmission routes, recent FDA findings revealed that 1 in 5 pasteurized milk samples were positive, and that human cases developed without direct animal exposure. Symptoms include sore throat, influenza-like illness, conjunctivitis, and seizures, and cases are identified through rRT-PCR testing and NP and conjunctival swabs.
“ H5N1 is not new,” Torres remarked.“ It has been around for more than 30 years at this point. The first human case was in southeast Asia and then began spreading globally. In the early 2000s, the World Health Organization( WHO) identified it as a potential global threat, because at that point, there was a significant appearance of human cases. That was the first signal that this could spread. Right now( Jue 2025) in the U. S. we have about 70 human cases, and for the majority, illness has been mild, and only one case has been linked to death. Most cases have been related to infected dairy cows and poultry farms. You’ re probably asking yourself,‘ At this point, why are we not hearing too much right now about human cases?’ and‘ Is this something that I need to be worried about?’ I can offer some reassurance that similar to us, likely there might have been some type of protection after an infection and that’ s something that may be true as well with cattle. It may have simply run out of the number of cattle that needs to be infected to cause significant numbers of cases. Also, expanded milk testing allowed for faster containment, and then I think there has been already so much burden in wild migratory birds that we have likely run out of the ones that needed to continue to get sick to spread this disease.”
Kley then reviewed the common infection prevention and control measures effective against both H5N1 and measles.
“ First and foremost, if you’ re not already doing
First, we need to talk about who’ s performing the cleaning and are they trained on using the proper PPE?”“ If you have that patient identified and in isolation, you’ re not going to want a lot of extra people in that room, so make sure that that nurse or trained observer or whoever’ s in there in that PPE is set up to clean whatever’ s coming your way.”
28 • www. healthcarehygienemagazine. com • jul-aug 2025